Wednesday, August 29, 2018

Shilla Growth Guidance Procedure
1.      What is the Shilla procedure? The Shilla technique is one which passively guides spine growth, rather than actively distracting across like a growing rod system.  I refer to it as a "track and trolley" system.

2.      Who is a candidate for the Shilla technique?  Many patients who are candidates for traditional growing rods (GR) are also candidates for the Shilla technique.  The decision between GR and Shilla technique will be made between the surgeon and parents/caregivers focusing on what is best for the child. 
3.      How is it different that traditional growing rods or MAGEC?  The Shilla fixes the worst part of the deformity, that part of the spine which is growing more sideways than vertically.  By straightening out the severely curved part and then fusing the apex of the deformity the apex will be permanently improved. A traditional growing rod or MAGEC system fixates above and below the worst part of the spine deformity and creates small fusions in the part of the spine which is growing more normally.  The growing rods are then forcefully distracted to put the spine under tension.  See reference #1 below for more details.

4.      Is Shilla better than traditional growing rods or MAGEC?  To this surgeon, if a Shilla can be used over a traditional growing rod or MAGEC then it is my first choice.  The question is why?  The initial surgery is similar between all three surgeries in terms of recovery.  The benefit of the Shilla is there is no need for repetitive surgeries, unlike traditional growing rods, or frequent clinic visits, as is necessary for MAGEC.  Overall, when Shilla is compared to growing rods the overall outcome on x-rays is nearly identical.  Another benefit is Shilla patients undergo 1/3 the number of surgeries/anesthesia when compared to traditional growing rods.  See reference #2 below.
5.      Is the spine fused in a Shilla procedure?  A spine fusion is performed typically over 2-4 vertebra where the scoliosis is at its worst.  These vertebra were not growing normally anyways.  Even if the patient had received a traditional growing rod or MAGEC that very curved part of the spine would not grow normally.

6.      How long will the Shilla procedure last? In the 2nd paper listed below it was demonstrated that they average patient underwent 3 surgeries: initial, one revision and then one final surgery.  The average patient underwent a revision surgery at 3-3.5 years after the first surgery and then final surgery at 6-7 years after the first surgery.  Every patient is different.
7.      When growth is completed what happens with the Shilla construct?  At or near the end of spine growth a decision is made to either convert the Shilla to a definitive spine fusion or removal all the implants with the idea to restore spine motion and not need a fusion surgery. 
8.      Whose decision is it to remove the implants or convert to a spine fusion?  It is a decision made by the patient, family and surgeon.  Most patients are undergoing definitive fusion surgery thus far because they wanted to improve their body position permanently.
9.      How many patients have had their implants removed? Thus far between our center and Little Rock there are less than 10 patients.
10.   If the implants are removed can a fusion surgery be done in the future?  Yes.

1.            Luhmann SJ, McCarthy RE.  A Comparison of SHILLA™ GROWTH GUIDANCE SYSTEM and Growing Rods in the Treatment of Spinal Deformity in Children Less than 10 Years of Age.  J Pediatr Orthop 37(8):e567-e574, 2017.
2.            Luhmann SJ, Smith JC, McClung A, et al.  Radiographic outcomes of Shilla Growth Guidance System and traditional growing rods through definitive treatment.  Spine Deformity, 5:277-282, 2017.
3.            Luhmann SJ, McAughey EM, Ackerman SJ, Bumpass DB, McCarthy R: Cost analysis of a growth guidance system compared with traditional and magnetically controlled growing rods for early-onset scoliosis: a US-based integrated health care delivery system perspective. ClinicoEconomics & Outcomes Research 1:179-187, 2018.